Evaluation of intra-abdominal solid organ injuries in children

Management of complex pediatric and adolescent liver trauma: adult vs pediatric level 1 trauma centers

PURPOSE

Management of high-grade pediatric and adolescent liver trauma can be complex. Studies suggest that variation exists at adult (ATC) vs pediatric trauma centers (PTC); however, there is limited granular comparative data. We sought to describe and compare the management and outcomes of complex pediatric and adolescent liver trauma between a level 1 ATC and two PTCs in a large metropolitan city.

METHODS

A retrospective review of pediatric and adolescent (age < 21 years) patients with American Association for the Surgery of Trauma (AAST) Grade 4 and 5 liver injuries managed at an ATC and PTCs between 2016 and 2022 was performed. Demographic, clinical, and outcome data were obtained at the ATC and PTCs. Primary outcomes included rates of operative management and use of interventional radiology (IR). Secondary outcomes included packed red blood cell (pRBC) utilization, intensive care unit (ICU) length of stay (LOS), and hospital LOS.

RESULTS

One hundred forty-four patients were identified, seventy-five at the ATC and sixty-nine at the PTC. The cohort was predominantly black (65.5%) males (63.5%). Six injuries (8.7%) at the PTC and forty-five (60%) injuries at the ATC were penetrating trauma. Comparing only blunt trauma, ATC patients had higher Injury Severity Score (median 37 vs 26) and ages (20 years vs 9 years). ATC patients were more likely to undergo operative management (26.7% vs 11.0%, p = 0.016) and utilized IR more (51.9% vs 4.8%, p < 0.001) compared to the PTC. The patients managed at the ATC required higher rates of pRBC transfusions though not statistically significant (p = 0.06). There were no differences in mortality, ICU, or hospital LOS.

CONCLUSION

Our retrospective review of high-grade pediatric and adolescent liver trauma demonstrated higher rates of IR and operating room use at the ATC compared to the PTC in the setting of higher Injury Severity Score and age. While the PTC successfully managed > 95% of Grade 4/5 liver injuries non-operatively, prospective data are needed to determine the optimal algorithm for management in the older adolescent population.

LEVEL OF EVIDENCE

Level IV.

Blunt Abdominal Trauma in Children: A Review of 105 Cases

Aims

The aim of the study is to identify the epidemiological, diagnostic, therapeutic, and evolutionary characteristics of patients admitted for blunt abdominal trauma (BAT) in a level 3 children's hospital.

Results

The frequency was 13.1 cases/year. The mean age was 6.6 years. The sex ratio was 3.56. Road traffic accidents were the most frequent cause (54.3%). Abdominal tenderness (88.6%) was the most common physical sign. Associated lesions were found in 40% of cases. Abdominal sonography (85.7%) was the most common imaging tool followed by an abdominal computed tomography scan (34.4%). The liver was the most affected organ (24.7%) and contusion was the most frequent lesion (65.4%). The majority of patients had received nonoperative treatment (93.3%). The average length of hospitalization was 5.6 days. The outcome in all cases was favorable. No mortality was reported.

Conclusions

BAT in children is common in boys under the age of 10. They are caused by road accidents. Physical examination combined with abdominal ultrasound is very important in the therapeutic decision, which in most cases is a conservative one. Morbidity and mortality are almost nil.

Blunt renal trauma in children: the experience of Mohammed VI University Hospital of Oujda in Morocco between 2015 and 2021

Introduction

blunt renal traumas in children are rare and their management is not suited to a very clear consensus. We sought to report our experience in managing renal injuries in children presented after blunt abdominal trauma.

Methods

data of children aged less than 16 years with blunt renal injuries between January 2015 and April 2021 were retrospectively reviewed. Demographic characteristics, clinical course, biological results, radiological findings, associated injuries, management and follow up of included patients were described. Renal lesions were classified according to the American Association for the Surgery of Trauma (AAST).

Results

we included a total of 20 children, of whom 70% (n=14) were males. The mean of age was 8.50 ± 3.42 years. Falls in 65% (n=13) and motor-vehicle accidents in 35% (n=7) were the two main mechanisms of injuries. Abdominal pain was the most common symptom and macroscopic hematuria was assessed in 55% of patients (n=11). Low-grade injuries (I-III) represented 40% of the cases (n=8), 60% of injuries were AAST grade IV (n=12) and none with AAST grade V was diagnosed. Spleen injuries in 25% (n=5) as well as traumatic brain injuries in 25% (n=5) were the most identified concomitant injuries followed by liver lesions in 15% (n=3). 75% of renal injuries (n=15) were managed conservatively and all cases that required an operative management were with AAST grade IV. No nephrectomy in our series was performed and the follow up was favorable with a median of 3 years.

Conclusion

our data suggest that the majority of children with blunt renal injuries can be managed conservatively regardless the grade of lesions as long as no hemodynamic instability or symptomatic urinoma are identified.